Neurosurgical Management and Outcome Parameters in 237 Patients with Spondylodiscitis.

Mirza Pojskić,Benjamin Völlger,Vincent Schmöckel,Christopher Nimsky,Benjamin Saβ,Barbara Carl

doi:10.3390/brainsci11081019

Abstract

Surgical treatment of spondylodiscitis allows for rapid mobilization and shortens hospital stays, which makes surgical treatment the first-line therapy. We aim to describe our experiences with operative treatment on spondylodiscitis and to determine the parameters that are important in the prediction of outcomes. A retrospective review identified 237 patients who were operatively treated for spondylodiscitis in our institution between January 2010 and December 2018. Clinical data were collected through review of electronic records and relevant imaging. In all cases, contrast-enhancing MRI from the infected region of the spine was obtained. Leukocyte count and C-reactive protein concentrations (CRP) were determined in all the patients. We included 237 patients in the study, 87 female (36.7%) and 150 male (63.3%), with a mean age of 71.4 years. Mean follow-up was 31.6 months. Forty-five patients had spondylodiscitis of the cervical, 73 of the thoracic, and 119 of the lumbosacral spine. All the patients with spondylodiscitis of the cervical spine received instrumentation. In thoracic and lumbar spine decompression, surgery without instrumentation was performed in 26 patients as immediate surgery and in a further 28 patients in the early stages following admission, while 138 patients received instrumentation. Eighty-nine patients (37.6%) had concomitant infections. Infection healing occurred in 89% of patients. Favorable outcomes were noted in patients without concomitant infections, with a normalized CRP value and in patients who received antibiotic therapy for more than six weeks (p < 0.05). Unfavorable outcomes were noted in patients with high CRP, postoperative spondylodiscitis, and recurrent spondylodiscitis (p < 0.05). Application of antibiotic therapy for more than six weeks and normalized CRP showed a correlation with favorable outcomes, whereas concomitant infections showed a correlation with unfavorable outcomes. A detailed screening for concomitant infectious diseases is recommended.

Highlights

Spondylodiscitis is a potentially life-threatening infection that has high morbidity rates [1]
Spondylodiscitis of the cervical spine was defined as an infection of one or more segments from C1/2 to C7/T1; spondylodiscitis of thoracic spine was defined as an infection in the segments
Osteosynthesis should be preferred for spondylodiscitis with osteolysis and spinal instability because it allows for early mobilization and rehabilitation, prevents spinal deformity and does not hamper the regression of infections [12]

Summary

Introduction

Spondylodiscitis is a potentially life-threatening infection that has high morbidity rates [1]. While vertebral osteomyelitis is rare, at a rate of 3–5%, it is the third most common form of osteomyelitis at >50 years of age [2,3]. Spondylodiscitis is usually a monobacterial infection and more than 50% of cases in Europe are caused by Staphylococcus aureus, followed by Gram-negative pathogens such as Escherichia coli (11–25%) [4,5]. The most common pathogen worldwide is Mycobacterium tuberculosis [4]. Brucellosis is endemic in the Mediterranean [6]. Rare causes include fungal infections like Coccidioidomycosis [7] and secondary syphilis [8]. While the literature has reported a low incidence of approximately

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